BILL S., AGE 85, suffered from macular degeneration,
mild dementia, skin cancer, and prostate cancer. He
lived in an assisted living facility, walked with a walker,
and was intensely lonely. His wife of 60 years had died,
and although he often forgot she was gone, tears came to
his eyes when he remembered. A smoker, he was ingenious
in discovering ways and places to smoke, even
though staff tried to stop him. When they took away his
lighter, he used the stove. When they disconnected the
stove, he used the toaster…and so on.
When a careless housekeeper left a pile of clothes on the
floor, Bill tripped over them and fell, suffering a subdural
hematoma. After his hospital stay, he returned to the facility
and was placed in the nursing-home section where
no smoking was allowed. He was often found trundling
along with his walker in the passageway to the assisted
living section, headed for his apartment where smoking
was allowed (if greatly discouraged). Management contacted
his daughter and asked them to authorize seclusion
because of his "wandering." His daughter refused,
and asked if her father had ever left the facility; management
said "No." Then she asked where her father was
found; management said either in his apartment or in the
hallway leading to it. His daughter said, "My father isn’t
wandering. He’s going to his own apartment, undoubtedly
so he can have a cigarette. He neither wants nor needs
seclusion." That night, the daughter was called and told
her father had "attacked a security guard." He was put in
seclusion—in full restraints. His daughter was asked to
immediately provide an orderly to sit with him 24 hours
a day, or he would be discharged immediately.
When she rushed to the facility to see her father, he
put his head on her shoulder and cried. "What," he
asked, "have I ever done to be treated like this?"
What indeed had he done? Nothing but try to live
his life—what was left of it—on his own terms. He was
paying for both an apartment and a nursing-home
room for a combined charge in excess of $12,000 per
month, and he wanted to have a cigarette. He had
smoked since he was 8 years old and had no intention
of quitting at age 85. For this reason, he was punished.
Let’s consider what age, debility, and illness can do to
a person’s humanity. First, one must go to another, often
a stranger, and ask for help. A previously independent
person who cared for himself (and often for others) is
no longer independent. This alone is a psychic wound.
Secondly, that person loses freedom of action: When ill
or aged or debilitated, you can’t command your body to
do what you want it to. So a second psychic wound occurs,
and is generally far more serious than the first. A
third wound occurs when illness or institutionalization
(or both) interferes with the ability (but not the right) to
make decisions about oneself within his own sphere. Bill didn’t break the rules; in fact, he was trying to comply with them. A corollary of these factors, and perhaps
the most devastating wound of all, is that he was placed
in the power of others. He was secluded, placed in fourpoint
restraints, and required to have constant attendants.
And he had no recourse. He was completely at
the mercy of the staff and his daughter.
Finally, age, debility, and illness can steal a person’s
right to define for himself who he is.
Quantum care demands nurses recognize and address
these wounds, and prevent or at least mitigate
their impact on a patient. It demands that we honor
the humanity of each individual; that we promote independence
and autonomy as much as possible; that
we use every means at our disposal to enable the decisions
people make and offer both the opportunity and
the means by which they can redefine for themselves
who they are and how they choose to live with their
advancing age, disability, or disease. Thus, these wounds
can, in some small measure, heal.
No matter how inconvenient, we respect a person’s
humanity—as we hope others will respect ours when
we are in their place.
Leah Curtin, RN, ScD(h), FAAN
Executive Editor, Professional Outreach
American Nurse Today
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Dr. Leah Curtin, RN, ScD (h), FAAN, is Executive Editor, Professional
Outreach, American Nurse Today. An internationally recognized
nurse leader, ethicist, speaker, and consultant, she is a strong
advocate for both the nursing profession and high-quality patient
care. Currently she is Clinical Professor of Nursing at the University
of Cincinnati College of Nursing and Health. Dr. Curtin can be
reached at LCurtin@healthcommedia.com.